August 28, 2012
I may have just stumbled upon some knowledge of muscular injuries that aren't caused by damage to muscle tissues. I find the potential discovery to be quite fascinating, somewhat understandable, and curiously absent as a common medical diagnosis.
On Saturday, August 18, I attended my usual District Crossfit class from 12:00 pm - 1:00 pm. I felt great during the workout. I felt great after the workout. And I felt great when I went to bed that night. All that was about to change dramatically! At 4:47 am on Sunday morning (yes, I remember and will never forget the exact time on the bedroom clock), I was rudely awakened by excruciatingly severe pain emanating from the groin area of my left hip. Unable to relieve the pain and resume sleeping, I called the BlueCross Nurse Hotline. At the suggestion of the nurse, I took Advil and alternated between 20 minutes of ice and 30 minutes of heat within each three-hour period. That treatment worked quite well and, by Monday morning, the pain was completely gone as I flew to Seattle for a meeting.
On the afternoon of Thursday, August 23, I returned to Washington, DC. The next day, Friday, I decided to resume attendance at District Crossfit and attended my regular time slot from 7:00 pm - 8:00 pm. I felt great during the workout. I felt great after the workout. And I felt great when I went to bed at around 9:30 pm that night. All that was about to change dramatically! At around 4:30 am, I awoke and noticed that my hip was starting to act up again. The pain wasn't as bad as it had been the week before, but it had very similar characteristics. This time, I was able to return to sleep. When I awoke again at 9:20 am, the pain was still present, but not much worse. I started the treatment cycle that I had used successfully the week before (Advil, ice, and heat) in the hope that it would relieve the pain just as it did the previous week. It didn't and my three-day trip to Hell and back began!
Over the next few hours, the pain had grown so bad, I began to wonder if it would ever go away. No matter what I did, it just kept getting worse. Eventually, there was no position of sitting, standing, or lying down that would relieve the pain completely. Saturday night arrived and I found myself praying for sleep. My prayer would not be answered. As the hours passed, I tried everything I could think of to relieve the pain to no avail. By 4:00 am, I decided to give the BlueCross Nurse Hotline another try since it operates all hours of the day. After describing the recurrence of the pain and the lack of response to the successful treatment of the week prior, the Nurse recommended that I call my doctor within 18 hours to get his recommendation. Since it was only around 4:00 am and I didn't see any benefit to waking up the on-call physician from my doctor's office, I decided to wait an extraordinarily long three hours and called at 7:00 am (this is now Sunday morning on a "Day of Rest").
Now is a good time to mention that I am in Washington, DC and my doctor's office is in Connecticut. So, in an attempt to save me from a visit to the local Emergency Department, the on-call physician decided to phone a prescription for Vicodin to the nearest CVS pharmacy that had Sunday hours. Unfortunately for me, even that pharmacy, half a mile from my apartment, didn't open until 10:00 am. There is a CVS on the ground floor of my building, but its pharmacy is closed on Sundays.
By now, the pain had radiated down my left thigh to my left knee. Remember this movement of pain for the discovery to be described at the end. I walked to the CVS to pick up the Vicodin prescription, which wasn't ready when I arrived just before 11:00 am, 30 minutes after the doctor had called it in. While waiting, I purchased a bottle of Mountain Dew and a bag of Peanut M&Ms. I saved much of the Mountain Dew for a bit later. Once my prescription was ready, I picked it up, walked outside, opened the bottle, and took the first pill with the remaining portion of Mountain Dew. I was hoping that taking the pill right there at the CVS would provide some pain relief by the time I made it back home. No such luck!
Though there was no relief from the pain, there was a benefit from taking the Vicodin. Having been wide awake for more than 27 hours straight, the Vicodin made me drowsy enough to fall asleep for up to two hours at a time. After another restless night with no reduction in pain, I was pretty certain this was going to lead to a visit to the Emergency Department. Before making that decision, however, i decided to contact my doctor's office one last time. They concurred that I should go to the Emergency Department, at least to get x-rays to rule out broken bones as the potential cause of the unrelenting pain.
Finally, just after 11:00 am on Monday, August 27, I was in a taxi (I was unable to walk by this point) on my way to the Emergency Department, which had become my final hope for any kind of pain relief. After 13 hours consisting of a lot of poking and prodding, a set of x-rays, two separate draws of blood, two or three doses of morphine, and a 46-minute MRI that seemed more like 46 hours, the doctors concluded that there was nothing structurally wrong with my hip. At just after midnight, I returned to my apartment knowing nothing more than I knew at the beginning of this adventure to the hospital and I was still in fairly excruciating pain. As it would turn out, however, my moment of discovery was just around the corner.
Due to the combined effects of morphine, extreme exhaustion, a starved belly made full, and whatever else, I was able to fall soundly asleep even though the intense pain was still present. When I awoke at about 6:22 am, I found that I was able to find numerous comfortable lying positions. Getting my left leg from the bed to the floor still invoked great pain, but not as much as the days before. I grabbed one of my two crutches and walked somewhat comfortably to the bathroom. I took a Vicodin tablet in the hope of keeping the pain from returning and allowing more sleep. It worked! I could start to see the light at the end of the tunnel from Hell.
As this Tuesday progressed, it would seem that the pain was going to dissipate as quickly and as mysteriously as it had arrived. By 6:00 pm, there were only a few positions related to lifting the left leg that caused even a tinge of pain. Now, I'm asking myself more questions than ever. Why did this intense pain come on so suddenly during sleep with no apparent cause? Why did it last so long and not react to pain medication? What made it dissipate so quickly once the dissipation began? Why did the numerous doctors of varying specialties at the hospital have no answers for cause or treatment?
This turned out to be an instance where life experiences provide answers when formal education doesn't. I recognized the strangeness of these conditions I had just experienced as being similar to an experience I had once before. It was a number of years ago. I had an intense pain that began on the left side of my chest and then radiated up over my shoulder to a point just beneath my left shoulder blade. Concerned that I may have been having a heart attack with those symptoms, I had my wife drive me to the nearest Urgent Care facility. After examining my heart and determining that it was not a heart-related incident, the doctor prescribed a muscle-relaxing medication. It was late at night and all local pharmacies were closed. The pain was so great, however, that I had to insist that we drive 30 miles away to an all-night pharmacy to get the prescription filled. I took the muscle relaxers and the pain subsided unbelievably fast!
Why do I correlate this latest muscle episode with the one I had several years ago? If all I needed was to relax my muscles to make the pain go away, then why did the pain last for nearly three full days? Why were pain medications ineffective at eliminating this pain? Why did the pain subside so suddenly and why was the timing as it was? To me, the answer now appears obvious. The medications and exhaustion allowed me to fall asleep for an extended period of time. The state of sleep caused my muscles to relax and the relaxing of the muscles allowed the pain to dissipate. If I had been able to somehow relax my muscles on Saturday, I would have avoided this little trip to Hell. Lesson learned, I hope!
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